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Baby First-aid: Choking

How to help a baby (under 12 months) to clear a blockage in the airway

Posted: 5 March 2008
by ThinkBaby

Choking happens as a result of a object blocking a person's airway so that s/he cannot breathe. In babies, choking is often caused by babies putting small objects into their mouths, which then become stuck, or by babies trying to swallow bits of food which are too big and become stuck. Often a baby who is in danger of choking will cough or gag to get rid of the object. If this happens it's best to let your baby cough or gag, while giving her support and encouragement, as this is the most effective way of preventing actual choking.

If your baby is unable to cough and is having difficulty breathing then you will have to take steps to clear the obstruction yourself. If your baby is choking you may notice that she can't breathe or cry, and she may start to turn blue. While this will be difficult, try to stay calm while you attempt to clear the blockage from your baby's airway.

The following applies for babies under 12 months of age. This should be used to refresh your memory and is no substitute for taking a first-aid course through an organisation like the St. John Ambulance, First Action or the Red Cross.

1. Assess the situation

  • Check to see whether there is a visible obstruction that you can remove from your baby's mouth. Only do this if you can grasp the object and pull it out as if you poke your fingers into the mouth you may push the object further in.
  • If you think that the baby's throat may have swollen shut due to a reaction or an infection then call 999 (or 112) immediately. If there is someone there with you then call for help or get them to call an ambulance as you try to help the baby. Never leave the baby alone to call for help, always give the baby simultaneous help to clear the blockage.

2. Give back slaps

  • Lie the baby face-down along your lower arm, with the baby's head lower down than their bottom. Support the baby's head with your hand and be sure the baby is well-supported on your arm - if necessary brace your arm against your thigh.
  • Using the heel of your hand, give the baby up to five firm slaps on the back, between the shoulder blades. After each slap check to see whether the blockage has cleared, you don't want to be slapping the baby unnecessarily. After each slap check for any visible blockage that you may be able to pick out.

3. Give chest thrusts

If after five back slaps the airway is not clear, give the baby up to five chest thrusts, again checking after each one to see whether the blockage has come clear. Note that a chest thrust is not the same as an abdominal thrust, which is used in choking emergencies in adults and children over 12 months.

  • Lie the baby along your lower arm again, this time on her back, with her head lower than her bottom. Support the baby's back and head with your arm and hand - if necessary brace your arm against your thigh.
  • Place three fingers in the centre of the baby's chest, with the middle finger central between the nipples, then lift up the middle finger and use the other two fingers, which should be one finger's breadth below the nipple line, to thrust. To thrust, push inwards and upwards against the baby's breastbone towards the head.
  • After each thrust, check to see whether the blockage has cleared or is now visible in the mouth and can be fished out, but again, only do this if you can remove the object or you risk pushing it further down. Give up to five thrusts.
If the blockage hasn't cleared after three cycles of back slaps and chest thrust then dial 999 (or 112) for an ambulance immediately. Do not leave the baby - take them with you. Continue with the cycles of back slaps and chest thrusts until help arrives.

Even once your baby can breathe again, some of the blockage may remain in the airway and may cause problems with coughing, swallowing or other complications. If your baby still has problems after the object seems to be cleared then you need to take her to A&E or your GP immediately. Even if your baby seems perfectly well after a choking episode, there may be complications caused by the attempts to clear her airways and you should take her for a check-up the same day.

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